[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5116 Introduced in House (IH)]







109th CONGRESS
  2d Session
                                H. R. 5116

  To amend title XVIII of the Social Security Act to extend the 2006 
initial enrollment period for the Medicare prescription drug benefit by 
  six months, to suspend the late enrollment penalty for such benefit 
during 2006, to permit Medicare beneficiaries to change enrollment in a 
     prescription drug plan once a year, and to prevent changes in 
formularies other than at the time of open enrollment periods and only 
                          with advance notice.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 6, 2006

   Mrs. Tauscher (for herself, Mr. Smith of Washington, Mr. Davis of 
Alabama, Mr. Kind, Mrs. McCarthy, Mr. Inslee, Ms. Herseth, Mr. Crowley, 
    Mr. Meeks of New York, Mr. Emanuel, Ms. Millender-McDonald, Mr. 
   Higgins, Ms. Harman, Mr. Price of North Carolina, Mr. Baird, Ms. 
  Schwartz of Pennsylvania, Mr. McIntyre, Mr. Engel, Mr. Israel, Mr. 
Chandler, Mr. Boswell, Ms. Loretta Sanchez of California, Mr. Larson of 
Connecticut, Mr. Davis of Florida, Mr. Moore of Kansas, and Ms. Hooley) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XVIII of the Social Security Act to extend the 2006 
initial enrollment period for the Medicare prescription drug benefit by 
  six months, to suspend the late enrollment penalty for such benefit 
during 2006, to permit Medicare beneficiaries to change enrollment in a 
     prescription drug plan once a year, and to prevent changes in 
formularies other than at the time of open enrollment periods and only 
                          with advance notice.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Choice for America's Seniors Act of 
2006''.

SEC. 2. SIX-MONTH EXTENSION OF 2006 INITIAL ENROLLMENT PERIOD FOR 
              MEDICARE PRESCRIPTION DRUG PLANS AND MA PLANS.

    (a) In General.--Section 1851(e)(3)(B)(iii) of the Social Security 
Act (42 U.S.C. 1395w-21(e)(3)(B)(iii)) is amended by striking ``May 15, 
2006'' and inserting ``November 14, 2006''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).

SEC. 3. SUSPENSION OF MEDICARE PRESCRIPTION DRUG LATE ENROLLMENT 
              PENALTY DURING 2006.

    (a) In General.--Section 1860D-13(b)(3)(B) of the Social Security 
Act (42 U.S.C. 1395w-113(b)(3)(B)) is amended by inserting ``(after 
December 2006)'' after ``any month''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).

SEC. 4. CHANGES OF ENROLLMENT IN PRESCRIPTION DRUG PLANS AND MA PLANS 
              ALLOWED TWICE DURING YEAR.

    (a) Additional Election Permitted Once Each Year Outside of Annual 
Coordinated Election Period.--Section 1851(e)(4) of the Social Security 
Act (42 U.S.C. 1395w-21(e)(4)) is amended by inserting ``once every 
year, and in addition,'' after ``make a new election under this 
section''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as of the date of the enactment of this Act.

SEC. 5. LIMITATION ON REMOVAL OR CHANGE OF COVERED PART D DRUGS FROM 
              THE PRESCRIPTION DRUG PLAN FORMULARY; NOTICE OF CHANGES 
              IN COVERAGE.

    (a) Limitation on Removal or Change of Covered Part D Drugs From 
the Prescription Drug Plan Formulary.--Section 1860D-4(b)(3)(E) of the 
Social Security Act (42 U.S.C. 1395w-104(b)(3)(E)) is amended to read 
as follows:
                    ``(E) Removing a drug from formulary or imposing a 
                restriction or limitation on coverage.--
                            ``(i) Limitation on removal, limitation, or 
                        restriction.--
                                    ``(I) In general.--Subject to 
                                subclause (II) and clause (ii), 
                                beginning with 2006, the PDP sponsor of 
                                a prescription drug plan may not remove 
                                a covered part D drug from the plan 
                                formulary or impose a restriction or 
                                limitation on the coverage of such a 
                                drug (such as through the application 
                                of a preferred status, usage 
                                restriction, step therapy, prior 
                                authorization, or quantity limitation) 
                                other than at the beginning of each 
                                plan year except as the Secretary may 
                                permit to take into account new 
                                therapeutic uses and newly covered part 
                                D drugs.
                                    ``(II) Special rule for newly 
                                enrolled individuals.--Subject to 
                                clause (ii), in the case of an 
                                individual who enrolls in a 
                                prescription drug plan on or after the 
                                date of enactment of this subparagraph, 
                                the PDP sponsor of such plan may not 
                                remove a covered part D drug from the 
                                plan formulary or impose a restriction 
                                or limitation on the coverage of such a 
                                drug (such as through the application 
                                of a preferred status, usage 
                                restriction, step therapy, prior 
                                authorization, or quantity limitation) 
                                during the period beginning on the date 
                                of such enrollment and ending on 
                                December 31 of the immediately 
                                succeeding plan year except as the 
                                Secretary may permit to take into 
                                account new therapeutic uses and newly 
                                covered part D drugs.
                            ``(ii) Exceptions to limitation on 
                        removal.--Clause (i) shall not apply with 
                        respect to a covered part D drug that--
                                    ``(I) is a brand name drug for 
                                which there is a generic drug approved 
                                under section 505(j) of the Food and 
                                Drug Cosmetic Act (21 U.S.C. 355(j)) 
                                that is placed on the market during the 
                                period in which there are limitations 
                                on removal or change in the formulary 
                                under subclause (I) or (II) of clause 
                                (i) if such generic drug is included in 
                                the formulary without any restriction 
                                or limitation placed on the coverage of 
                                such generic drug other than a 
                                restriction or limitation that would be 
                                placed on the coverage of the brand 
                                name drug during such period without 
                                the application of this clause;
                                    ``(II) is a brand name drug that 
                                goes off-patent during such period;
                                    ``(III) is a drug for which the 
                                Commissioner of Food and Drugs issues a 
                                clinical warning that imposes a 
                                restriction or limitation on the drug 
                                during such period;
                                    ``(IV) is a drug that the 
                                appropriate pharmacy and therapeutic 
                                committee determines, based on evidence 
                                from peer-reviewed medical research, to 
                                be unsafe or ineffective during such 
                                period; or
                                    ``(V) is any other drug that 
                                satisfies any other requirement 
                                determined appropriate by the 
                                Secretary.
                            ``(iii) Notice of removal under application 
                        of exception to limitation.--Not later than 90 
                        days before a PDP sponsor of a prescription 
                        drug plan removes a covered part D drug from 
                        the plan formulary (or restricts or limits such 
                        coverage) under clause (ii), the sponsor shall 
                        provide appropriate notice (such as under 
                        subsection (a)(3)) of such removal (or 
                        restriction or limitation) to the Secretary, 
                        affected enrollees, physicians, pharmacies, and 
                        pharmacists.''.
    (a) Advance Notice Required for Change in Formulary and Other 
Restrictions or Limitations on Coverage.--
            (1) In general.--Section 1860D-4(a) of the Social Security 
        Act (42 U.S.C. 1395w-104(a)) is amended by adding at the end 
        the following new paragraph:
            ``(5) Annual notice of changes in formulary and other 
        restrictions or limitations on coverage.--Each PDP sponsor 
        offering a prescription drug plan shall furnish to each 
        enrollee 90 days before the time of each annual coordinated 
        election period (referred to in section 1860D-1(b)(1)(B)(iii)) 
        for a plan year a notice of any changes in the formulary or 
        other restrictions or limitations on coverage of a covered part 
        D drug under the plan that will take effect for the plan 
        year.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to annual coordinated election periods beginning 
        after the date of the enactment of this Act, except that if 
        this Act is enacted after September 15, 2006, and before 
        January 1, 2007, the notice required under such section shall 
        apply with respect to the annual coordinated election period 
        that begins on November 15, 2006, as of such date (as soon as 
        possible after such date of enactment) as the Secretary of 
        Health and Human Services shall specify.
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